Canadian Rheumatology Association Guidance for Developing & Endorsing Quality Measures to Support Learning Health Systems.

OBJECTIVE To review methods for developing and endorsing Quality Measures (QMs) to inform a national quality measurement framework for rheumatology care in Canada. METHODS We conducted a rapid environmental scan of measure development organizations from Canada, the United Kingdom, the United States and Australia. Major phases in the development of QMs were abstracted. The results were reviewed and synthesized with members of the Canadian Rheumatology Association's Digital Measurement Subcommittee through iterative review across 3 virtual meetings. The guidance was approved at the committee and the CRA board level. RESULTS Five key steps in the measure development cycle are proposed including: conceptualization and prioritization, measure specification development, testing and validation, implementation and reporting, continuous evaluation and maintenance. Foundational to all phases is the engagement of individuals from diverse backgrounds with lived experience of disease, healthcare providers, quality measurement scientists, and partner organizations. Measures should be aligned with domains of quality (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness of care delivery) and be developed transparently. Endorsement of future QMs should, at minimum, prioritize validity, feasibility and acceptability or use/usability. CONCLUSION This paper establishes a comprehensive and relevant framework for the development and/or endorsement of QMs in Canadian rheumatology care. This framework will permit streamlining of future quality improvement efforts at the national level.